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The Science. Outdated approach vs a new approach.

Running has become increasingly popular around the world over the last three decades. At the same time running footwear has gone from simple shoes to a high tech product featuring advanced cushioning technologies and motion control devices. Still, it is estimated that between 40-70% of all runners suffer at least one injury per year. This has of course partly to do with the repetitive nature of running, where the runner takes approximately 1000 steps per kilometer and at each foot landing the body endure of load of 3-5 times the body weight.

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Outdated and over simplistic approach

Traditional foot landing analysis is in our view over simplistic and an outdated approach. Further, it is an outdated approach to select a shoe according to arch type (flat, normal or high arch).

The standard procedure of treating a runner and assigning footwear is asking a few standardized questions regarding mileage, running conditions and evaluating the current running shoes. After this a biomechanical assessment of the runner’s feet is done. What most people do not realize is that there is no evidence-based research existing on recommending one particular shoe model over another for given foot type or injury history, despite what some manufacturers claim.

If the runner is visiting a more specialized clinic, a gait analysis is sometimes performed. When put on a treadmill, the runner is normally wearing traditional Running shoes and the video camera is filming foot strike from behind. In that situation the foot becomes a loose adaptor when the heel is striking the ground. Over pronation is most likely diagnosed. In an effort to control this excessive motion - Motion control shoes with a dual density midsole is prescribed.

The support of the medial foot arch has often been proposed as one of the most effective corrections of motion control. The “duo density” midsole construction was the technical solution in the last thirty years. This technology has been used more or less by all footwear companies. However, the frequency of running related injuries did not change significantly in this period of time.

It is today evident that the mechanical concept of motion control by duo density midsole technology did not meet the expectations to decrease the risk of injuries.

The problem with the outdated approach is that it does not focus on finding the root cause for the injury or preventing injuries.

The New approach – Full Body Running Analysis™

Running technique or running form is traditionally ignored as means to prevent injury and improve running efficiency. However, research evidence suggests the key is, understanding that running technique, form and training patterns play a more significant role on improving ones running and at the same time reducing injuries.

It’s evident that improving your running technique could enable you to run faster with less effort, but research also shows that “developing a better running stride mechanics and neuromuscular control is shown to be effective in preventing injury”.

Instead of Running on the treadmill videotaping only from behind. We believe that a holistic approach is more adequate - A Full Body Running analysis™, analyzing your running technique by means of our motion capture system that records your every move with great precision. What happens at foot landing can normally derived from somewhere else and should be corrected at the source. You get visual feedback in a web based report that shows you some key-parameters in a good running technique, such as pelvic rotation, knee angle, ankle flexion, arm swing and foot contact etc. You get useful tips on things you should consider, improving you running form. We promote a holistic approach towards running and a whole body in function. Therefore, your report also includes a training program, including movability exercises and/or co-ordinations drills and/or strengthen exercises for certain muscles that will help you improve your running technique.

Below you will find a reference guide to a selection of peer reviewed research and science published in the most credible journals over the last 30 years.

Concepts and definitions

Human motion sequences

“Gait” is the medical term to describe human locomotion. The gait can be divided into two phases:
1) Stance – defined as the interval in which the foot is on the ground.
2) Swing – defined as the interval in which the foot is not in contact with the ground. Below we will focus on the stance phase, when and how the foot strikes the ground.

Walking gait

Walking gait starts with the heel making contact with the ground in front of the body (center of mass), and then the foot rolls forward to mid stance and finally moves over to the propulsion phase where the foot leaves the ground off its toes.

A Walking gait is extremely efficient for Walking, hence the name - Walking gait. It does not involve all of the muscles we have in our body for running, like the Achilles tendon, and gluteal muscle (seat muscle).

Using a Walking gait (heel strike running) for running can have several disadvantages, for example:

  • high impact stress on foot strike (when the heel hits the ground)
  • more torsional forces at the knee joints – risk for Runner’s knee
  • high off-center axis load on shin muscles – risk for Shin splints
  • loss of tension in Achilles tendon and ankle – foot becomes a loose adaptor – risk for over pronation
  • over striding – foot strike in front of center of mass – running with breaks on - against gravity

Running gait

Running gait starts with the foot striking the ground close to mid foot/ball of foot under the center of mass. Ideally with a pre-tension in the foot (see Salming Runninng Wheel). The whole foot is brought down as quickly as possible – focus is on reducing ground contact time. A minimum of energy is lost as foot strike occurs under the center of mass.

Additional benefits include full use of your body’s natural cushioning and spring biomechanics.

  • Your body’s natural cushioning anatomy includes the Arch, Achilles tendon, bent knee, s-shaped spine.

Recycling is a beautiful and timely concept and in running – your body has a built-in “energy return” system – isn’t that wonderful! The Achilles tendon (biggest spring in your body) and other tendons recycle impact energy. As the foot hits the ground, impact energy is stored in the muscles and tendons. This energy is then used to spring the body forward.

Sprinting gait

The arch, Achilles tendon, bent knee and S-shaped spine are all parts of the human body’s natural cushioning anatomy. The correct running form make best use of these tools as opposed to marketing hyped cushioning materials that claim to do the job for you.

Natural cushioning anatomy

In sprinting, the gait typically features a forefoot strike further up on the foot, than distance running. Sprinting gait is very energy consuming and demands a lot from your calf muscles. Therefore, Sprinting gait is normally used only for sprint distances up to 400 meters.

Running on the forefoot and maybe not even bringing the whole foot down is not recommended for long distance running as it puts to much stress on the Achilles tendon and calf muscles.

Recycled energy

Your body recycles energy, in fact it has a built-in “energy return” system. The Achilles tendon and other tendons recycle impact energy. As the foot hits the ground, impact energy is stored in the muscles and tendons. This energy is then used to spring the body forward.

The arch is constructed as a flexible and elastic web that consist of 26 bones, 33 joints, 12 elastic tendons and 18 muscles that all tense and stretch together and functions like a spring when Running naturally. Approximately 17% of the mechanic energy when running is stored and released by this spring alone, according to Dr Lieberman.

Achilles tendon - your body’s largest spring starts at the back of the heel, runs up the leg and attaches into the large calf muscles. When Running, the Achilles tendon spring stores up and releases approximately 35% of the impact energy hitting the ground – energy for free.

This springy energy is very different from the marketing hyped rebound materials that claim to make wonders for you. In fact, cushioned midsole actually steals energy from your body’s natural elastic energy/recoil. The thicker the midsole the more energy lost.

It has however been found in a recent study that a lightweight running shoe with a thin midsole can be more efficient than barefoot running. It is believed that the reason for this is that the little extra weight of the lightweight shoe consumes less extra energy in comparison to the energy the body has to use when working with taking the impact forces when running barefoot.

Pronation and Supination

During walking and running, pronation and supination normally occur in the foot. Pronation is important for optimal movement and shock absorption. During foot strike, the foot begins to roll inward and the arch flattens. This is called pronation. It is a normal action—one that occurs in every step in every healthy foot. The purpose of this is to loosen the foot so it can adapt to the surface, especially in uneven terrain.

Following pronation, as the foot continues through its gait, supination occurs. This results in the foot turning slightly outward then changing from a flexible foot to becoming rigid so it can propel the foot and push off from the ground. During this phase the foot inverts slightly, and the arches become higher, thus enabling the foot to properly roll over the big toe.

A number of factors can disrupt a person‘s normal gait. Two of the most common reasons are muscle imbalance and wearing stiff, over-supportive shoes.

The notion that some people are pronators while others are supinator is a gross oversimplification and mostly a marketing hype. Everyone pronates and supinates. The reason some people excessively pronate or supinate is more often from wearing over-supportive shoes. You need to be extra careful with children; their feet need to properly develop without shoes or wearing flexible shoes.

More importantly, the shoe industry’s range of motion control shoes is an example of treating the symptom with a mechanic solution built into the footwear rather than finding the root cause of the problem. The New Approach focus on running technique and form. In Salming RunLab we perform a detailed Full Body Running Analysis™ in order to help the runner to run more efficiently and injury free. Salming Running Wheel and Salming Academy provide free instructions on how to improve your running technique and form, wearing Natural running shoes facilitate this transition.

Proprioception

Nobody in their right mind would wear ski gloves when typing on a keyboard. Why is it then that we should have shoes with a thick midsole when we are running? It is a myth that the feet need to be extremely carefully protected.

The ball of foot area has a lot of receptors responsible for sending communication from the foot to the brain. The brain immediately responds and the body adapts to variation in surfaces. If a too thick midsole is placed between the ground and the foot it distorts this communication. The body becomes less able to adapt the correct running technique, form and foot landing.

For example, the human body in not designed to cope with the large initial impact force created by a heel strike when running, consequently if you walk bare feet and then start to run you body will immediately adjust from the walking heel strike to mid foot strike when running. Now, if you place a really thick cushioned midsole underneath your feet you brain will not sense the initial impact force you encounter when you switch from walking to running and therefore not adjust from a heel strike to mid foot strike.

The Reports

1. MOTION CONTROL/ STRUCTURED SHOES - BASED ON FOOT VALVE OR RUNNING STRIDE

Injury Reduction Effectiveness of Assigning Running Shoes Based on Plantar Shape in Marine Corps Basic Training

SEPTEMBER 01, 2010


The American Journal of Sports Medicine,

September 2010 vol. 38 no. 9 1759-1767


AUTHORS: Joseph J. Knapik, Daniel W. Trone, David I. Swedler, Adriana Villasenor, Steve H. Bullock, Emily Schmied, Timothy Bockelman, Peggy Han, and Bruce H. Jones

Background: Shoe manufacturers market motion control, stability, and cushioned shoes for plantar shapes defined as low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics.

Hypothesis: Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training.

Conclusion: This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.

 

The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial


MAY 10, 2010


British Journal of Sports Medicine, doi:10.1136/bjsm.2009.069849


AUTHORS: Michael B Ryan, Gordon A Valiant, Kymberly McDonald, Jack E

Background: The present study examines the injury status in women runners who are randomised to receive a neutral, stability or motion control running shoe.

Conclusion: The findings of this study suggest that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.

 

Is your prescription of distance running shoes evidence based?

APRIL 18, 2008


British Journal of Sports Medicine


AUTHORS: Criag E Richards; Parker J Magin; Robin Callister

Objectives: To determine whether the current practice of prescribing distance running shoes featuring elevated cushioned heels and pronation control systems tailored to the individual’s foot type is evidence-based.

Results: No original research that met the study criteria was identified either directly or via the findings of the six systematic reviews identified.

Conclusion: The prescription of this shoe type to distance runners is not evidence-based.

Motion Control Concepts Revisited

JUNE 29, 2007


8th Footwear Biomechanics Symposium - Taipei 2007


AUTHORS: Gert-Peter Brüggemann - Institute of Biomechanics and Orthopedics - German Sport University Cologne, Germany

Conclusion: Motion control concepts are used for more than 20 years in running footwear. The frequency of running related injuries did not change significantly in this period of time. Remarkably even the injury distribution and location were not affected. The relative number of knee and shank injuries did no differ when comparing data reported from the same group (Clement et al. 1981, Taunton et al. 2002). One can conclude that the purely mechanical concept of motion control by duo density midsole technology did not meet the expectations to decrease the risk of injuries. The skeleton changes its path of movement for a given task only minimally and non systematic when exposed to a mechanical intervention. The locomotor system seems to choose a strategy to keep a “minimal resistance movement path” (Wilson et al. 1996). An optimal or appropriate shoe concept would affect muscle activity and muscle force potential rather than a mechanical support.

 

Kinematically mediated effects of sport shoe design: a review

JANUARY 01, 1986


Journal of Sports Science, 1986 Winter;4(3):169-84.


AUTHORS: Frederick EC.


One prominent pattern emerging from a review of the literature on sport shoes and biomechanics is the observation that many effects are the indirect result of shoe-induced adjustments in movement, i.e. a particular shoe characteristic elicits a kinematic adaptation which in turn has secondary consequences on kinetics and on injury and performance. For example, in addition to its variable effects on peak forces, cushioning system design has been shown to alter electromyographic patterns and to affect knee flexion during foot strike and affect indirectly the economy of running. Mediolateral stability as measured by rearfoot kinematics is strongly influenced by shoe design features such as heel lift, and sole hardness and geometry. The frictional properties of the shoe and surface interface have also been shown to affect kinematics in a way that in turn affects the recorded frictional forces themselves. Such kinematically mediated responses are the most provocative result of studies of the biomechanical effects of footwear. It is becoming apparent that the shoe can be a powerful tool for manipulating human movement. The abundance of shoe design possibilities coupled with the body's tendency to adjust in predictable ways to shoe mechanical characteristics have given us a new way to manipulate human kinematics and kinetics, as well as a convenient model for studying biomechanical adaptation.

2. HEEL VS MIDFOOT/ FOREFOOT LANDING IMPACT FORCES AND MIDSOLE CUSHIONING

Impact characteristics in shod and barefoot running

MARCH 01, 2011


Footwear Science – The Official Journal of the Footwear Biomechanics Group, Volume 3, Issue 1, 01 Mar 2011


AUTHORS: Joseph Hamilla, Elizabeth M. Russella, Allison H. Grubera, Ross Millera

Increased impact characteristics are often cited as a cause of running injuries. One method that has been used to reduce impact characteristics is to increase the thickness of the midsole of running footwear with the intention of attenuating greater shock from the foot-ground collision. A second method that has been suggested is to run barefoot. The purpose of this study was to compare the impact characteristics of running footwear of different midsole thickness to a barefoot condition. Three-dimensional kinematic and kinetic data were collected as participants ran at their preferred running speed and at a fixed speed. Impact characteristics (impact peak, time to impact peak and vertical loading rate) were derived from the vertical ground reaction force component. Ankle and knee joint stiffness during the loading phase of support were derived from the change in moment divided by the change in angle. The impact parameters were statistically analyzed using a two-way, repeated measures ANOVA. There were no significant speed by footwear condition interactions. For impact peak, ankle stiffness and knee stiffness, there was no difference among the shod conditions but there were significant differences between the shod and barefoot conditions. Based on their strike index, participants in this study appeared to alter their footfall pattern from a rearfoot to a midfoot pattern when changing from running shod to barefoot. It may be concluded that the change in the impact characteristics is a result of changing footfall pattern rather than midsole thickness.

 

Foot strike patterns and collision forces in habitually barefoot versus shod runners

JANUARY 28, 2010


Nature – International Weekly Journal of Science,
 Nature 463, 531-535 (28 January 2010)


AUTHORS: Daniel E. Lieberman, Madhusudhan Venkadesan, William A. Werbel, Adam I. Daoud, Susan D’Andrea, Irene S. Davis, Robert Ojiambo Mang’Eni & Yannis

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

Foot Strike Patterns of Runners At the 15-Km Point During An Elite-Level Half Marathon

AUGUST 01, 2007


Journal of Strength and Conditioning Research, Volume 21 Issue 3


AUTHORS: Hasegwa, Hiroshi; Yamauchi, Takeshi; Kraemer, William J.

The purpose of the present study was to document actual foot strike patterns during a half marathon in which elite international level runners, including Olympians, compete.

Conclusion: The findings of this study indicate that foot strike patterns are related to running speed. The percentage of RFS increases with the decreasing of the running speed; conversely, the percentage of MFS increases as the running speed increases. A shorter contact time and a higher frequency of inversion at the foot contact might contribute to higher running economy.

 

Biomechanical analysis of the stance phase during barefoot and shod running

MARCH 01, 2000


Journal of Biomech, 2000 Mar;33(3):269-78.


AUTHORS: De Wit B, De Clercq D, Aerts P. Department of Movement and Sport Sciences, University of Ghent, Belgium.

This study investigated spatio-temporal variables, ground reaction forces and sagittal and frontal plane kinematics during the stance phase of nine trained subjects running barefoot and shod at three different velocities. Therefore, it is assumed that runners adopt this different touchdown geometry in barefoot running in an attempt to limit the local pressure underneath the heel. A significantly higher leg stiffness during the stance phase was found for the barefoot condition. The sagittal kinematic adaptations between conditions were found in the same way for all subjects and at the three running velocities. However, large individual variations were observed between the runners for the rearfoot kinematics.

3. RUNNING EFFICIENCY

Metabolic cost of running barefoot versus shod: is lighter better?

AUGUST 01, 2012


Medicine and Science Sports and Exercise, 2012 Aug;44(8):1519-25


AUTHORS: Franz JR, Wierzbinski CM, Kram R

Purpose: Based on mass alone, one might intuit that running barefoot would exact a lower metabolic cost than running in shoes.

Conclusion: Running barefoot offers no metabolic advantage over running in lightweight, cushioned shoes.

 

Effects of footwear and strike type on running economy

JULY 01, 2012


Medicine and Science in Sport and Exercise, 
2012 July; 44(7);1335-43


AUTHORS: Perl DP, Daoud AI, Lieberman DE.

Purpose: This study tests if running economy differs in minimal shoes versus standard running shoes with cushioned elevated heels and arch supports and in forefoot versus rearfoot strike gaits.

Conclusion: Minimally shod runners are modestly but significantly more economical than traditionally shod runners regardless of strike type, after controlling for shoe mass and stride frequency. The likely cause of this difference is more elastic energy storage and release in the lower extremity during minimal-shoe running.

Barefoot-shod running differences: shoe or mass effect?


 JUNE 01, 2008


International Journal of Sports Medicine, 
2008 Jun;29(6):512-8.


AUTHORS: Divert C, Mornieux G, Freychat P, Baly L, Mayer F, Belli A.

The higher oxygen consumption reported when shod running is compared to barefoot running has been attributed to the additional mass of the shoe. However, it has been reported that wearing shoes also modified the running pattern. The aim of this study was to distinguish the mass and shoe effects on the mechanics and energetics when shod running. Twelve trained subjects ran on a 3-D treadmill ergometer at 3.61 m . s (-1) in six conditions: barefoot, using ultra thin diving socks unloaded, loaded with 150 g, loaded with 350 g, and two shoe conditions, one weighing 150 g and another 350 g. The results show that there was a significant mass effect but no shoe effect for oxygen consumption. Stride frequency, anterior-posterior impulse, vertical stiffness, leg stiffness, and mechanical work were significantly higher in barefoot condition compared to shod. Net efficiency, which has metabolic and mechanical components, decreased in the shod condition. The mechanical modifications of running showed that the main role of the shoe was to attenuate the foot-ground impact by adding damping material. However, these changes may lead to a decrease of the storage and restitution of elastic energy capacity which could explain the lower net efficiency reported in shod running.

 

Effects of shoes and foot orthotics on VO2 and selected frontal plane knee kinematics

FEBRUARY 01, 1985


Medicine and Science in Sport and Exercise, 1985 Feb;17(1):158-63.


AUTHORS: Burkett LN, Kohrt WM, Buchbinder R.

The objective of this study was to investigate the effects of shoes and foot orthotics on running economy and selected frontal plane knee kinematics during the support phase of running. Results from the mechanical aspect of this study indicate that there were no significant differences among the means for linear displacement of the knee. Angular displacement of the knee during barefoot running was significantly (P less than 0.05) less than shoe and shoe-plus-orthotic conditions. There was no difference, however, between shoes and shoes plus orthotics. The economy results revealed that the aerobic cost of running increased as the amount of mass added to the foot increased.

4. INJURIES

Treating Running injuries: Form vs Footwear

JANUARY 01, 2013


January 2013 issue of Podiatry Management. It was written on behalf of the American Academy of Podiatric Sports Medicine


AUTHORS: Nicholas A. Campitelli, DPM, FACFAS Podiatrist, Foot and Ankle Surgeon

In conclusion, it seems that most practitioners are straying from the path of helping a runner by focusing on shoes as opposed to form. The term “appropriate shoe” is a misnomer when viewed by the old paradigm of selecting a shoe according to arch type, and many are still advocating shoes this way. A running shoe should allow the foot to function as it was designed to – naturally without inhibiting motion. Adding cushioned heels and motion control mechanisms can inhibit this. By viewing shoes as the first line of treatment for most conditions, we must make sure this does not interfere with the foot’s natural function.

 

Relationships among self-reported shoe type, footstrike pattern, and injury incidence

OCTOBER 01, 2012


US Army Med Dep J., 2012 Oct-Dec:25-30.


AUTHORS: Goss DL, Gross MT. US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas, USA.

Context: Some runners are experimenting with barefoot or minimalist shoe running to reduce lower extremity overuse injuries. However, there has been little research to examine injury trends associated with barefoot or minimalist shoe running.

Objective: To assess the association of self-reported shoe selection with reported foot strike patterns, compare overall injury incidence associated with different shoe conditions, and identify differences in injury location between different shoe conditions. Results: Shoe selection was significantly associated with reported footstrike (χ² (4df) =143.4, P<.001). Barefoot and minimalist runners reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were 3.41 times more likely to report injuries than experienced minimalist shoe wearers (46.7% shod vs 13.7% minimalist, χ² (1df) =77.4, P<.001, n=888). Minimalist shoe wearers also reported fewer injuries at the hip, knee, lower leg, ankle, and foot than traditionally shod runners.

Conclusion: Barefoot and minimalist shoe wearers reported a more anterior footstrike than traditionally shod runners. Traditionally shod runners were more likely to report injuries of the lower extremities than runners who wear minimalist shoes. Additional longitudinal prospective research is required to examine injury incidence among various footstrike patterns and shoe preferences.

 

Foot strike and Injury Rates in Endurance Runners: A Retrospective Study

JULY 01, 2012


Medicine and Science in Sport and Exercise, July - 44(7):1325-34


AUTHORS: Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE

Purpose: This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike. Conclusion: Competitive cross-country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared with a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.

 

Forefoot Running Improves Pain and Disability Associated With Chronic Exertional Compartment Syndrome

MARCH 16, 2012


The American Journal of Sports Medicine, March 2011


AUTHORS: Angela R. Diebal, PT, DSc (angie.diebal@us.army.mil), Robert Gregory, PhD, Curtis Alitz, MD and J. Parry Gerber, PT, PhD

Background: Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners.

Hypothesis: For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition.

Conclusion: In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients.

 

Effects of step rate manipulation on joint mechanics during running

FEBRUARY 01, 2011


Medicine and Science in Sport and Exercise 
Feb - 43(2):296-302


AUTHORS: Heiderscheit BS, Chumanov ES, Michalski MP, Wille CM, Ryan MB

The objective of this study was to characterize the biomechanical effects of step rate modification during running on the hip, knee, and ankle joints so as to evaluate a potential strategy to reduce lower extremity loading and risk for injury. Results: Less mechanical energy was absorbed at the knee during the +5% and +10% step rate conditions, whereas the hip absorbed less energy during the +10% condition only. All joints displayed substantially more energy absorption when preferred step rate was reduced by 10%. Step length, center of mass vertical excursion, braking impulse, and peak knee flexion angle were observed to decrease with increasing step rate. When step rate was increased 10% above preferred, peak hip adduction angle and peak hip adduction and internal rotation moments were found to decrease. We conclude that subtle increases in step rate can substantially reduce the loading to the hip and knee joints during running and may prove beneficial in the prevention and treatment of common running-related injuries.

 

Barefoot running strikes back

JANUARY 28, 2010


Nature – International Weekly Journal of Science, 
Nature 463, 433-434 (28 January 2010)


AUTHORS: William L. Jungers

Detailed analyses of foot kinematics and kinetics in barefoot and shod runners offer a refined understanding of bipedalism in human evolution. Conclusion: Foorfoot/Midfoot runners can take fuller advantage of of elastic energy storage in both the Achilles tendon and the longitudinal arch of the foot. FF/MF runners therefore require more calf- and footmuscle strength, but avoid uncomfortable and potentially injurious impact transients.

 

The Effect of Running Shoes on Lower Extremity Joint Torques


DECEMBER 01, 2009


The American Academy of Physical Medicine and Rehabilitation
, Volume 1, Issue 12, Pages 1058-1063, December 2009


AUTHORS: D Cassey Kerrigan, Jason R. Franz, Geoffrey S. Keenan, Jay Dicharry, Ugo Della Croce, Robert P. Wilder

Results: Increased joint torques at the hip, knee, and ankle were observed with running shoes compared with running barefoot. Disproportionately large increases were observed in the hip internal rotation torque and in the knee flexion and knee varus torques. An average 54% increase in the hip internal rotation torque, a 36% increase in knee flexion torque, and a 38% increase in knee varus torque were measured when running in running shoes compared with barefoot.

Conclusion: The findings at the knee suggest relatively greater pressures at anatomical sites that are typically more prone to knee osteoarthritis, the medial and patellofemoral compartments.

 Effects of stride length and running mileage on a probabilistic stress fracture model

DECEMBER 01, 2009


Medicine and Science in Sport and Exercise, 2009 Dec;41(12):2177-84


AUTHORS: Edwards WB, Taylor D, Rudolphi TJ, Gillette JC, Derrick TR.

The fatigue life of bone is inversely related to strain magnitude. Decreasing stride length is a potential mechanism of strain reduction during running. If stride length is decreased, the number of loading cycles will increase for a given mileage. It is unclear if increased loading cycles are detrimental to skeletal health despite reductions in strain. Purpose: To determine the effects of stride length and running mileage on the probability of tibial stress fracture. Conclusions: Results suggest that strain magnitude plays a more important role in stress fracture development than the total number of loading cycles. Runners wishing to decrease their probability for tibial stress fracture may benefit from a 10% reduction in stride length.

 

Foot and Ankle Injuries in the Barefoot Sports

SEPTEMBER 01, 2009


American College of Sports Medicine, September/October 2009 - Volume 8 - Issue 5


AUTHORS: Vormittag, Kara; Calonje, Ronald; Briner, William W.


Playing sports barefoot has been contested since the very beginnings of athletic competition. Even today, some data suggest that shoes may limit the adaptive pronation that occurs after footstrike during running gait. This pronation likely protects runners from injury. Boardsport participants who perform their sports barefoot on the water seem to be at risk for foot and ankle injuries. The high-impact forces in gymnastics place participants at risk for foot and ankle injuries, as well. Swimming and diving have a low rate of foot and ankle injuries. The risk of ankle sprain in beach volleyball, which is played barefoot, seems to be lower than that for indoor volleyball, played wearing shoes. Martial arts place competitors at risk for injuries to the foot and ankle from torsional and impact mechanisms. Athletes who hope to return to barefoot competition after injury should perform their rehabilitation in their bare feet.

 

Preventing running injuries through barefoot activity: sometimes "dressing out" means not putting on your shoes

APRIL 01, 2008


The Journal of Physical Education, Recreation and Dance, 
April 2008


AUTHORS: Hart, Priscilla M.; Smith, Darla R

The purpose of this article is to describe for coaches and runners the theory behind the use of barefoot activity as a method of reducing running injuries. Conclusion: In summary, internal strengthening is often overlooked as a method of preventing running injuries. Key factors to consider when implementing a barefoot activity program are: (1) maintaining a running and injury journal to compare current progress and prior injury frequency; (2) gradually increasing the time spent and the variance of terrain; (3) decreasing shoe support, if desired, to more flexible and thin midsoles on a gradual and incremental basis; and (4) being consistent and persistent, because strengthened structures weaken with cessation of barefoot activity (Robbins & Hanna, 1986).

 

Barefoot Running


JANUARY 01, 2001


Sport Science
, 5(3), sportsci.org/jour/0103/mw.htm, 2001


AUTHORS: Michael Warburton

Conclusions: - Running in shoes appears to increase the risk of ankle sprains, either by decreasing awareness of foot position or by increasing the twisting torque on the ankle during a stumble. - Running in shoes appears to increase the risk of plantar fasciitis and other chronic injuries of the lower limb by modifying the transfer of shock to muscles and supporting structures. - Running in bare feet reduces oxygen consumption by a few percent. Competitive running performance should therefore improve by a similar amount, but there has been no published research comparing the effect of barefoot and shod running on simulated or real competitive running performance. - Research is needed to establish why runners choose not to run barefoot. Concern about puncture wounds, bruising, thermal injury, and overuse injury during the adaptation period are possibilities. - Running shoes play an important protective role on some courses, in extreme weather conditions, and with certain pathologies of the lower limb.

 

Running-related injury prevention through innate impact-moderating behavior

APRIL 01, 1989


Medicine and Science in Sport and Exercise, 
Vol. 21, No. 2, pp. 130-139, 1989.


AUTHORS: Robbins, S. E., G. J. Gouw, A. M. Hanna.

Running-related injury prevention through innate impact-moderating behavior. Med. Sci. Sports Exerc, Vol. 21, No. 2, pp. 130-139, 1989. The purpose of these experiments was to test the Robbins and Hanna hypothesis, which relates differences in discomfort from localized deformation at certain positions on the plantar surface to protective behavior (intrinsic foot shock absorption).

Results: These data further support the notion that plantar sensory feedback plays a central role in safe and effective locomotion.

 

On the epidemiology of running injuries The 1984 Bern Grand-Prix study

JUNE 01, 1988


The American Journal of Sports Medicine, June 1988 vol. 16 no. 3 285-294


AUTHORS: Bernard Marti, John Paul Vader, Christoph E. Minder, Theodor Abelin

Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occurrence of jogging injuries was independently associated with higher weekly mileage (P < 0.001), history of previous running injuries (P < 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older runners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recommending jogging, moderation should be the watchword.

5. STRIDE

Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners

MARCH 01, 2009


Journal of Sports Medicine and Physical Fitness, 
2009 Mar;49(1):6-13.


AUTHORS: Squadrone R, Gallozzi C 

The first aim of this study was to assess how changes in the mechanical characteristics of the foot/shoe-ground interface affect spatio-temporal variables, ground pressure distribution, sagittal plane kinematics, and running economy in 8 experienced barefoot runners. The second aim was to assess if a special lightweight shoe was effective in mimic the experience of barefoot running.

Results: Compared to the standard shod condition when running barefoot the athletes landed in more plantarflexion at the ankle. This caused reduced impact forces and changes in stride kinematics. In particular, significantly shorter stride length and contact times and higher stride frequency were observed.

Conclusions: The data of this study support the assumption that changes in the foot-ground interface led to changes in running pattern in a group of experienced barefoot runners.

6. CUSHIONING

Are old running shoes detrimental to your feet? A pedobarographic study.

AUGUST 01, 2011


Biomedical Central Res Notes, 2011 Aug 24;4:307. doi: 10.1186/1756-0500-4-307


AUTHORS: Rethnam U, Makwana N. Department of Orthopaedics, Glan Clwyd Hospital, Rhyl, UK. ulfinr@yahoo.com.

Background: Footwear characteristics have been implicated in fatigue and foot pain. The recommended time for changing running shoes is every 500 miles. The aim of our study was to assess and compare plantar peak pressures and pressure time integrals in new and old running shoes.

Conclusion: Plantar pressure measurements in general were higher in new running shoes. This could be due to the lack of flexibility in new running shoes. The risk of injury to the foot and ankle would appear to be higher if running shoes are changed frequently. We recommend breaking into new running shoes slowly using them for mild physical activity.

 

Running in new and worn shoes: a comparison of three types of cushioning footwear

OCTOBER 01, 2009


British Journal of Sports Med, 2009 Oct;43(10):745-9. doi: 10.1136/bjsm.2008.047761. Epub 2008 Sep 18.


AUTHORS: P W Kong, N G Candelaria, D R Smith

Objectives: In this study, the effect of shoe degradation on running biomechanics by comparing the kinetics and kinematics of running in new and worn shoes was investigated. Three types of footwear using different cushioning technologies were compared.

Conclusions: As shoe cushioning capability decreases, runners modify their patterns to maintain constant external loads. The adaptation strategies to shoe degradation were unaffected by different cushioning technologies, suggesting runners should choose shoes for reasons other than cushioning technology.

 

Do you get value for money when you buy an expensive pair of running shoes?


OCTOBER 11, 2007


British Journal of Sports Medicine
, 42:189-193 doi:10.1136/bjsm.2007.038844


AUTHORS: R Clinghan, G P Arnold, T S Drew, L A Cochrane, R J Abboud
Objective: This investigation aims to determine if more expensive running shoes provide better cushioning of plantar pressure and are more comfortable than low-cost alternatives from the same brand. Conclusions: Low- and medium-cost running shoes in each of the three brands tested provided the same (if not better) cushioning of plantar pressure as high-cost running shoes. Cushioning was comparable when walking and running on a treadmill. Comfort is a subjective sensation based on individual preferences and was not related to either the distribution of plantar pressure or cost.

 

Hazard of deceptive advertising of athletic footwear

JANUARY 01, 1997


British Journal of Sports Medicine, 
1997;31:299-303 doi:10.1136/bjsm.31.4.299


AUTHORS: S Robbins, E Waked


Objectives: Athletic footwear are associated with frequent injury that are thought to result from repetitive impact. No scientific data suggest they protect well. Expensive athletic shoes are deceptively advertised to safeguard well through "cushioning impact", yet account for 123% greater injury frequency than the cheapest ones. This study tested the hypothesis that deceptive advertising creates a false sense of security with users of expensive athletic shoes, inducing attenuation of impact moderating behavior, increased impact, and injury.

Conclusions: These data provide a plausible mechanism explaining higher injury frequency in users of expensive athletic shoes. This is the first report to suggest: (1) deceptive advertising of protective devices may represent a public health hazard and may have to be eliminated presumably through regulation; (2) a tendency in humans to be less cautious when using new devices of unknown benefit because of overly positive attitudes associated with new technology and novel devices.

Influence of shoes and heel strike on the loading of the hip joint

JULY 01, 1995


Journal of Biomechanics, 
Volume 28, Issue 7 , Pages 817-827, July 1995


AUTHORS: G. Bergmann, H. Kniggendorf, F. Graichen, A. Rohlmann

The forces and moments acting at the hip joint influence the long-term stability of the fixation of endoprostheses and the course of coxarthrosis. These loads may depend on the kind of footwear and the walking or running style. These factors were investigated in a patient with instrumented hip implants. He wore different sports shoes, normal leather shoes, hiking boots and clogs and walked barefoot with soft, normal and hard heel strikes. The loads were lowest while walking and jogging without shoes. All shoes increased the joint force and the bending moment at the implant slightly, but the torsional moment rose by up to 50%. No relation was found between the different type of shoes and the load increase, only shoes with very hard soles were clearly disadvantageous. Soft heels, soles or insoles did not offer advantages. Gait stability seems to play the most important role in increasing the joint loading and should be the criterion for the choice of footwear.

 

A kinetic evaluation of the effects of in vivo loading on running shoes.


OCTOBER 01, 1988


The Journal of Orthopedic and Sports Physical Therapy, 
1988;10(2):47-53.


AUTHORS: Hamill J, Bates BT

The purpose of the study was to assess the effects of repeated in vivo loading on shock attenuation and mediolateral stability of running shoes using ground reaction force data.The results support previous findings that material properties of the systems evaluated deteriorated resulting in a loss of shock absorbing capabilities (7.3%) but the magnitudes of the losses were far less than previously reported results (23-40%). The reason for this discrepancy is presumed to be the result of the different loading and evaluation methods used in the present study. The results also suggest that these changes are not totally deleterious since foot control seems to improve as cushioning is lost and foot control accounts for at least half of running shoe related injuries.

 

Running-related injury prevention through barefoot adaptations

APRIL 01, 1987


Medical Science in Sports & Exerc., 1987 Apr;19(2):148-56.


AUTHORS: Robbins SE, Hanna AM.

A number of reports indicate an extremely low running-related injury frequency in barefoot populations in contrast to reports about shod populations. It is hypothesized that the adaptations which produce shock absorption, an inherent consequence of barefoot activity and a mechanism responsible for the low injury frequency in unshod populations, are related to deflection of the medial longitudinal arch of the foot on loading. It is also hypothesized that the known inability of this arch of the shod foot to deflect without failure (foot rigidity) is responsible for the high injury frequency in shod populations. Changes occurred in the medial longitudinal arch which allowed deflection of this arch on loading which substantiated the hypotheses. Other evidence suggests that sensory feedback largely from the glabrous epithelium of the foot is the element of barefoot activity which induced these adaptations. The sensory insulation inherent in the modern running shoe appears responsible for the high injury frequency associated with running.

 

Effects of shoe cushioning upon ground reaction forces in running

NOVEMBER 01, 1983


International Journal of Sports Medicine,
 1983 Nov;4(4):247-51.


AUTHORS: Clarke TE, Frederick EC, Cooper LB

To determine the effects of widely varying amounts of cushioning upon vertical force (VF) parameters, ten male subjects, (mean weight = 68.0 kg) ran at a speed of 4.5 m . s-1 (6 min/mile pace) and contacted a Kistler force platform. Two shoes were tested: a hard one and a softer shoe that had 50% more cushioning as measured by an instrumented impact tester. It was found [force magnitudes expressed in multiples of body weight (BW)] that the time to the vertical force impact peak (VFIP) was significantly longer (hard = 22.5 ms, soft = 26.6 ms) in the soft shoe; however, no differences were seen in the magnitudes (hard = 2.30 BW, soft = 2.34 BW). The minimum after the VFIP was also significantly delayed in the soft shoe (hard = 33.8 ms, soft = 37.9 ms) and was significantly greater in the soft shoe (hard = 1.46 BW, soft = 1.90 BW). The peak VF propulsive force occurred statistically at the same time in both shoes (hard = 85.7 ms, soft = 84.0 ms), but was significantly greater in the soft shoe (hard = 2.73 BW, soft = 2.83 BW)

 

7. CHILDREN

Effect of children's shoes on gait: a systematic review and meta-analysis

JANUARY 01, 2011


Journal of Foot Ankle Res., 2011 Jan 18;4:3. doi: 10.1186/1757-1146-4-3.


AUTHORS: Wegener C, Hunt AE, Vanwanseele B, Burns J, Smith RM.

Background: The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running.

Conclusion: shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.

 

Barefoot running and walking: the pros and cons based on current evidence

APRIL 18, 2008


Journal of the New Zealand Medical Association, 
18-April-2008, Vol 121 No 1272


AUTHORS: Keith Rome, Dene Hancock, Daniel Poratt

In response to the recent debate on barefoot running and walking of children published in the New Zealand Herald we have put together an argument relating to the pros and cons based on current evidence. There is very limited evidence specifically relating to barefoot running and walking in children. One study from Germany reported that the increased prevalence of flatfoot and hallux valgus (bunions) in modern societies may be the consequence of inadequate footwear in childhood. The German study postulated that barefoot walking represents the best condition for the development of a healthy foot. Walking and running on different types of surfaces such as grass, sand, and artificial running tracks may indeed enhance healthy foot development. However, the problem of barefoot walking on hard surfaces such as pavements may alter the biomechanics of walking and running. This may lead to potential arthritic changes and consequently a reduction in foot function. However, a study from Germany reports shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended for children of all ages.

 

 

Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes

JANUARY 01, 2008


Gait Posture, 2008 Jan;27(1):51-9. Epub 2007 Mar 13


AUTHORS: Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Department of Orthopedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. Sebastian.Wolf@ok.uni-hd.de

The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inadequate footwear in childhood. Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot the objective of this study was to monitor the influence of commercial footwear on children's foot motion during walking. Furthermore, an attempt was made to reduce this influence by changing the physical properties of standard footwear. Conclusion: The present study shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended not only for children in this age but for healthy children in general.

 

The Influence of Footwear on the Prevalence of Flat Foot

JULY 01, 1992


Kasturba, Medical College, Manipal, India, 
VOL. 74-B. No. 4, JULY 1992


AUTHORS: Udaya Bhaskara, Rao Benjamin Joseph

We analysed static footprints of 2300 children between the ages of four and 13 years to establish the influence of footwear on the prevalence of flat foot. The incidence among children who used footwear was 8.6% compared with 2.8% in those who did not (p < 0.001). Significant differences between the predominance in shod and unshed children were noted in all age groups, most marked in those with generalised ligament laxity. Flat foot was most common in children who wore closed-toe shoes, less common in those who wore sandals or slippers, and least in the unshod. Our findings suggest that shoe-wearing in early childhood is detrimental to the development of a normal longitudinal arch.

8. OTHER ARTICLES OF INTEREST

The foot core system: a new paradigm for understanding intrinsic foot muscle function

MARCH 11, 2014


British Journal of Sports Medicine, Br J Sports Med doi:10.1136/bjsports-2013-092690


AUTHORS: Patrick O McKeon, Jay Hertel, Dennis Bramble, Irene Davis

The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run. The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. However, the intrinsic muscles are largely ignored by clinicians and researchers. As such, these muscles are seldom addressed in rehabilitation programmes. Interventions for foot-related problems are more often directed at externally supporting the foot rather than training these muscles to function as they are designed. In this paper, we propose a novel paradigm for understanding the function of the foot. We begin with an overview of the evolution of the human foot with a focus on the development of the arch. This is followed by a description of the foot intrinsic muscles and their relationship to the extrinsic muscles. We draw the parallels between the small muscles of the trunk region that make up the lumbopelvic core and the intrinsic foot muscles, introducing the concept of the foot core. We then integrate the concept of the foot core into the assessment and treatment of the foot. Finally, we call for an increased awareness of the importance of the foot core stability to normal foot and lower extremity function.

Injury Free Running

JUNE 05, 2013


www.naturalrunningcenter.com


AUTHORS: Various authors